Garratt K N, Holmes D R, Roubin G S
Division of Cardiovascular Diseases and Internal Medicine, University of Alabama, Birmingham, Alabama.
Mayo Clin Proc. 1991 Mar;66(3):268-75. doi: 10.1016/s0025-6196(12)61008-8.
After percutaneous transluminal coronary angioplasty, 3 to 7% of patients have in-hospital coronary closure, and the risk of subsequent myocardial infarction is high, even with an urgent bypass operation. Disrupted coronary morphologic integrity, particularly with large dissections, may be associated with an increased risk of acute coronary closure. A percutaneously placed coronary vascular stent may rapidly alleviate acute or threatened coronary closure and could reduce morbidity. Between October 1989 and June 1990, placement of a balloon-expandable, flexible metallic coil (Gianturco-Roubin) coronary stent was attempted 16 times in 15 Mayo Clinic patients--for treatment of actual or threatened abrupt coronary closure in 10 patients, for primary treatment of a lesion judged to be at high risk for dissection with conventional balloon angioplasty in 1, and for elective treatment of restenotic lesions in 5. Placement of the stent was successful in 15 attempts (94%). Associated complications, which were uncommon, were similar to those noted after balloon angioplasty. No early deaths occurred, and no patient required coronary artery bypass grafting. Stents were successfully placed in both urgent and elective circumstances in native coronary arteries and saphenous vein grafts, and they were used in primary atheromatous and restenotic lesions. Our initial experience with this metallic coil stent indicates that it is efficacious for vascular disruption that is threatening or causing coronary closure after angioplasty. Furthermore, elective placement of a stent may be safely undertaken in patients with high-risk coronary lesions or recurrent restenotic lesions. The long-term outcome in all groups of patients who receive coronary stents is unknown.
经皮腔内冠状动脉成形术后，3%至7%的患者会发生院内冠状动脉闭塞，即便进行紧急搭桥手术，后续发生心肌梗死的风险依然很高。冠状动脉形态完整性遭到破坏，尤其是出现大的夹层时，可能会增加急性冠状动脉闭塞的风险。经皮置入冠状动脉血管支架可迅速缓解急性或濒临的冠状动脉闭塞，并能降低发病率。1989年10月至1990年6月期间，梅奥诊所的15名患者尝试了16次置入球囊可扩张的柔性金属线圈（Gianturco-Roubin）冠状动脉支架——其中10名患者用于治疗实际发生的或濒临的冠状动脉突然闭塞，1名患者用于对经传统球囊血管成形术判断有高夹层风险的病变进行初次治疗，5名患者用于对再狭窄病变进行择期治疗。15次尝试中14次成功置入支架（成功率94%）。相关并发症并不常见，与球囊血管成形术后所观察到的并发症相似。未发生早期死亡，也没有患者需要进行冠状动脉旁路移植术。支架在紧急和择期情况下均成功置入天然冠状动脉和大隐静脉移植血管中，并用于原发性动脉粥样硬化病变和再狭窄病变。我们对这种金属线圈支架的初步经验表明，它对血管破裂有效，这种破裂在血管成形术后威胁或导致冠状动脉闭塞。此外，对于有高危冠状动脉病变或复发性再狭窄病变的患者，可安全地进行支架择期置入。接受冠状动脉支架治疗的所有患者组的长期预后尚不清楚。
